Interim maritime labour certificate

Issued under the provisions of Article V and Title 5 of the

Maritime Labour Convention, 2006

(referred to below as "the Convention")

under the authority of the Government of:

..................................................................

(full designation of the State whose flag the ship is entitled

to fly)

by ...............................................................

(full designation and address of the competent authority

or recognized organization duly authorized under

the provisions of the Convention)

Particulars of the ship

Name of ship .....................................................

Distinctive number or letters ....................................

Port of registry .................................................

Date of registry .................................................

Gross tonnage <*> ................................................

IMO number .......................................................

Type of ship .....................................................

Name and address of the shipowner <**> ...........................

..................................................................

This is to certify, for the purposes of Standard A5.1.3, paragraph 7, of the Convention, that:

(a) this ship has been inspected, as far as reasonable and practicable, for the matters listed in Appendix A5-I to the Convention, taking into account verification of items under (b), (c) and (d) below;

(b) the shipowner has demonstrated to the competent authority or recognized organization that the ship has adequate procedures to comply with the Convention;

(c) the master is familiar with the requirements of the Convention and the responsibilities for implementation; and

(d) relevant information has been submitted to the competent authority or recognized organization to produce a Declaration of Maritime Labour Compliance.

This Certificate is valid until ................... subject to

inspections in accordance with Standards A5.1.3 and A5.1.4.

Completion date of the inspection referred to under (a) above

was ..........................................................

Issued at ...................... on ..........................

Signature of the duly authorized official

issuing the interim certificate...............................

(Seal or stamp of issuing authority, as appropriate)

--------------------------------

<*> For ships covered by the tonnage measurement interim scheme adopted by the IMO, the gross tonnage is that which is included in the REMARKS column of the International Tonnage Certificate (1969). See Article II (1) (c) of the Convention.

<**> Shipowner means the owner of the ship or another organization or person, such as the manager, agent or bareboat charterer, who has assumed the responsibility for the operation of the ship from the owner and who, on assuming such responsibility, has agreed to take over the duties and responsibilities imposed on shipowners in accordance with this Convention, regardless of whether any other organizations or persons fulfil certain of the duties or responsibilities on behalf of the shipowner. See Article II (1) (j) of the Convention.

Appendix A5-III

General areas that are subject to a detailed inspection by an authorized officer in a port of a Member carrying out a port State inspection pursuant to Standard A5.2.1:

Minimum age

Medical certification

Qualifications of seafarers

Seafarers' employment agreements

Use of any licensed or certified or regulated private recruitment and placement service

Hours of work or rest

Manning levels for the ship

Accommodation

On-board recreational facilities

Food and catering

Health and safety and accident prevention

On-board medical care

On-board complaint procedures

Payment of wages

Appendix B5-I